Signs that should not be ignored —- headache
Headache is pain confined to the upper part of the skull, including the arch of the eyebrows, the upper edge of the ear chakra and the external occipital ridge, and is one of the most common clinical syndromes.
It is one of the most common clinical syndromes. Prevalence of headache: Almost everyone has had a headache at one time or another (90% of people will experience a headache within a year and only 1% will be spared for life). In the United States, 28 million people suffer from migraines each year. Worldwide, there are approximately 600 million migraineurs each year. Headache is one of the most common complaints encountered by community physicians. Twenty percent of patients contacted by neurologists complain of headaches.
Pathogenesis.
1. Vascular factors: constriction and dilation of intracranial and extracranial blood vessels and traction or stretching of blood vessels due to various causes (traction and compression of blood vessels by intracranial occupying lesions). 2. Irritation or pulling of the meninges. 3. 3. Stimulation, compression or pulling of the nociceptive brain nerves (5, 9, 10 pairs of brain nerves) and cervical nerves. 4. contraction of head and neck muscles. 5. lesions of the five senses and cervical spine. 6. biochemical factors and endocrine disorders. 7.Nerve function disorder.
According to the classification of the International Headache Society, functional headache is classified as follows: periodic headache, migraine, tension-type headache, cluster headache and chronic paroxysmal hemiplegia, headache caused by non-organic lesions, headache caused by cranial trauma, headache caused by vascular disease, headache caused by vascular intracranial disease, headache caused by the application of other objects and machinery, headache caused by non-cranial infection, headache caused by metabolic diseases Headache, headache or facial pain caused by cranial, cervical, ocular, ear, nasal, paranasal sinus, dental, oral, facial or other structural disorders of the head, cranial neuralgia, afferent headache of nerve stem pain and cervicogenic headache, etc.
1. Cranial lesions (1) Infection meningitis, meningoencephalitis, encephalitis, brain abscess, etc. (2) Vascular lesions: subarachnoid hemorrhage, cerebral hemorrhage, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, cerebral blood supply deficiency, cerebrovascular malformation, thrombo-occlusive vasculitis, etc. (3) Occupational lesions: brain tumor, intracranial metastatic carcinoma, intracranial leukemic infiltration, intracranial porcine cysticercosis (cysticercosis) or echinococcosis (encysticercosis), etc. (4) Cranial trauma: such as concussion, cerebral contusion, subdural hematoma, intracranial hematoma, and sequelae of traumatic brain injury. (5) Other: such as migraine, cluster headache (histamine headache), headache epilepsy. 2. extracranial lesions 1) cranial bone diseases: such as skull base concavity, cranial tumor. (2) Cervical spondylosis and other neck diseases. (3) Neuralgia: such as trigeminal nerve, linguopharyngeal nerve and occipital neuralgia. (4) Headache due to eye, ear, nose and dental diseases. 3.Neurosis neurasthenia and hysterical headache. 3.Systemic diseases
(1) Acute infection: febrile diseases such as influenza, typhoid, pneumonia, etc.
(2) Cardiovascular diseases: such as hypertension, heart failure.
(3) Poisoning: such as lead, alcohol, carbon monoxide, organophosphorus, drugs (such as belladonna, salicylates) and other poisoning.
(4) Others: uremia, hypoglycemia, anemia, pulmonary encephalopathy, systemic lupus erythematosus, menstrual and menopausal headache, heat stroke, etc.
Several common types of headache
Migraine (migraine)
Migraine is often preceded by an aura of flashing lights, blurred vision, and numbness of the limbs for a few minutes to an hour or so.
A throbbing pain on one side of the head appears and gradually increases in intensity.
The sensation does not improve until after nausea and vomiting occur,
The headache is relieved in a quiet, dark environment or after sleep.
The headache may be preceded by or accompanied by neurological or psychiatric dysfunction.
General type (1988 diagnostic criteria)
1) At least 5 episodes of headache, meeting 2 to 4 of the following criteria.
2) If untreated, each attack lasts 24 hours.
3) At least two of the following characteristics are present: unilateral; throbbing; afraid to move; headache worsens after activity.
4) One of the following during the attack: nausea and vomiting; photophobia and phonophobia.
5) No other known similar disease; history of normal body.
Typical migraine
1) At least 2 episodes of both of the following.
2) At least 3 of the following characteristics: 1 or more aura symptoms with limited cortical or brainstem dysfunction; at least one aura symptom that develops gradually and lasts more than 4 minutes; or 2 or more symptoms occurring one after another; aura symptoms lasting <6 minutes; no interval between aura and headache.
3) Having more than one of the following characteristics: no evidence of organic disease; possible organic disease, but ancillary tests to exclude; no association with migraine despite organic disease.
Treatment
Treatment of acute attacks
Prophylactic treatment
Treatment of acute attacks is aimed at
Relief of headache.
Reduction of concomitant symptoms, such as nausea and vomiting, photophobia and phonophobia.
To reduce exertional loss due to attacks and to improve quality of life
Drug therapy
Non-specific medications: acetaminophen, aspirin, non-steroidal anti-inflammatory drugs, opioids (oral, nasal spray, injections), etc.
Note: inexpensive, over-the-counter medications.
However, long-term application, reduced efficiency, high recurrence rate of headache, significant rebound after discontinuation, high possibility of addiction with frequent use, gastrointestinal and other organ damage.
Atopic drugs.
Selective pentoxifylline agonists: tretinoin: almotriptan, sumatriptan. Zolmitriptan.
Non-selective pentraxin agonists: ergotamine, dihydroergotamine, etc
How to use?
Use effective dose.
Regular oral ibuprofen 200mg ,repeated for 4-6h
The first oral dose of 600mg-800mg is recommended to increase the efficiency of remission.
Early treatment
Avoid oral medications that tend to cause rebound headache: e.g. caffeine/acetaminophen/aspirin combination, (caffeine is the main risk factor for rebound headache and chronic headache), caffeine overdose can cause nervousness, tremors, insomnia and anxiety, insomnia, so insomnia is also another factor for persistent headache.
Dangers of frequent use of rebound headache medications
Increased incidence of headache attacks
Increased dose of painkiller application
Relative ineffectiveness of prophylactic drugs and drugs that specifically stop headaches, such as traptans
Increased headache with opioids, drug overdose and addiction
Therefore, painkillers that cause rebound headaches must be discontinued prior to migraine prophylaxis.
How is it treated?
Stepwise treatment (pyramid) if the diagnosis is established
Satisfactory first-line (simple) pain medication, continue treatment
Unsatisfactory, follow-up, second-line pain medication (combination pain medication)
Unsatisfactory, follow-up, third-line therapy (specific anti-migraine medication)
Unsatisfactory, search for cause and explore further treatment options
Disadvantages: delay in effective treatment, waste of resources, poor adherence.
Common types of painkillers
Class I: Non-steroidal anti-inflammatory drugs. Aspirin, ibuprofen, anti-inflammatory pain, paracetamol, phentermine, rofecoxib, celecoxib, etc. The pain-relieving effect is relatively weak, without addictive properties, widely used, with precise efficacy, for general common pain. Such as cold, fever, muscle aches, flu, fatigue headache, neuralgia.
The second category: central painkillers. Tramadol, represented by synthetic central painkillers, is a Class II psychotropic drug. The pain relief effect of tramadol is stronger than that of general antipyretic painkillers, and its pain relief effect is 1/10 of that of morphine, which is mainly used for moderate acute pain and post-surgical pain, etc.
The third category: narcotic painkillers. It is represented by codeine, morphine, dulcolax and other opioids, including weak opioids and strong opioids. The pain-relieving effect is strong, but long-term use can become addictive. These drugs have a strict management system and are mainly used for patients with advanced cancer. (1) Weak opioids: represented by codeine, which can cause respiratory depression. There are also dextropropoxyphene and oxycodone, and prednisone; ② strong opioids: represented by morphine, commonly used are oral morphine regular and controlled-release tablets, as well as buprenorphine, fentanyl, methandienol, and dulcolax.
The fourth category: antispasmodic and analgesic drugs. Mainly used for the treatment of spasmodic pain of gastrointestinal and other smooth muscles, such as gastrointestinal, biliary, urinary tract colic representative drugs include atropine, probenecid, epilepsy tablets, scopolamine, etc.
The fifth category: anxiolytic painkillers: headache patients are often accompanied by anxiety, tension and anxiety. In patients with tension headache, the tension and contraction of the facial muscles make the headache more severe, so anti-anxiety drugs can stabilize the emotions and relax the muscles, so they are also used in the treatment of headache. Representative drugs include Valium.
Staging treatment
The purpose of graded treatment is to meet the needs of different treatments according to the degree of attack
For severe attacks with loss of work capacity, effective specific analgesics are given.
Patients with light loss of work capacity, who do not have strong treatment requirements, should be given simple painkillers
In short, be flexible, graded and stepwise treatment.
A few simple methods are taught to you.
Was the headache significantly reduced within 2 hours of taking the drug?
Was this medication taken only once?
Did you resume normal social activities, family life and ability to work soon after treatment?
Is the treatment tolerated?
If the answer is yes, the treatment remains unchanged.
If one or more of the answers is no
Combination of NSAIDs and Treprostin medication is recommended
Preferably NSAIDs are preferred for pain relief
If no relief after 2 hours of oral administration, take 1 treprostatin-based drug
If NSAIDs are ineffective or not tolerated, use a single treprostatin
Prophylactic treatment of migraine
Objective.
To reduce the frequency, severity, and duration of migraine attacks
Delay the loss of delayed work capacity and improve the quality of life.
To increase the response to seizure termination therapy during acute attacks.
If you have the following conditions.
Migraine that affects your daily life even after acute treatment is given.
Work abandonment due to low productivity.
The daily life of the family is affected and you are unable to enjoy social and leisure activities.
Preventive treatment needs to be considered.